Diane Roth, PsyNP
Psychiatric Nurse Practitioner
Child and Adolescent Psychiatry
New Patient Pre-registration
Prior to booking your appointment, register your information with us and download our new patient paperwork. Please click our registration button to the side to be redirected to pre-registration.
**If the new patient paperwork is not completed prior to your scheduled appointment, your appointment will need to be rescheduled.**
Request Records
We are happy to send copies of records of your visit(s). Please fill out our "Consent to Release Information" form, and your request will be processed within 30 days. Please have all relevant addresses or fax numbers available. If extraneous paperwork needs to be filled out by Diane, there may be a charge incurred. Fees may be incurred for completing FMLA paperwork, social security forms, extensive school forms, or diagnosis letters.
After completing the release of information form, please email or fax it to our office.